Background & objective: The prognosis of relapsed or refractory B-cell lymphoma is poor, with a short-term survival after conventional second-line chemotherapy. Rituximab, a chimeric anti-CD20 antigen, in combination with CHOP or CHOP-like chemotherapy may improve both disease-freely survival and overall survival of naive patients, but it's role in the second-line treatment for relapsed non-Hodgkin's lymphoma (NHL) is uncertain. This study was to evaluate the efficacy of rituximab-containing salvage regimens on relapsed or refractory NHL, and observe the toxicities.

Methods: Clinical data of 35 patients with relapsed or refractory NHL, treated in Cancer Center of Sun Yat-sen University, were analyzed retrospectively. Of the 35 patients, 19 were man, and 16 were women, with a median age of 53.5 years (ranged from 21 to 77); for ECOG performance status, 33 (94.3%) scored 0-1; for international prognostic index (IPI), 20 (57.1%) scored 0-1, 7 (20%) scored 2, 4 (11.4%) scored 3, and 4 (11.4%) scored 4-5; 23 cases of diffuse large B-cell lymphoma (DLBL) accounted for 65.7% among all subtypes. Rituximab (375 mg/m2) was administered intravenously at the day before each chemotherapy cycle. The second-or third-line salvage regimens included EPOCH, CHOP, DHAP, DICE, IVAC, IMVP-16, and FND.

Results: Of the 35 patients, 30 received rituximab-combined regimens, and 5 received rituximab alone. A total of 102 cycles of rituximab-containing salvage regimens were administered. The objective response rate of the 32 evaluable cases was 68.8%, with a complete remission (CR) rate of 40.6%; 3 patients achieved CR after radiotherapy following rituximab-based regimens, and 3 achieved CR after autologous hematopoietic stem cell transplantation. The most frequent adverse events were nausea, leukopenia, and alopecia. The addition of rituximab to chemotherapy only elevated the occurrence of mild infusion-related reactions, such as chills, fever, and pruritus. The median follow-up time was 12.5 months (ranged from 3 to 69 months); 2 patients were lost, 10 were died (9 died of lymphoma, and 1 died of severe hepatitis), the other patients remained alive. The median progression-freely survival was 11.8 months (ranged from 3 to 33 months). The overall 1-, 2-, and 3-year survival rates were 72.9%, 62.8%, and 62.8%, respectively.

Conclusion: Rituximab-containing salvage regimens are effective and well tolerated, even in extensively pretreated patients with relapsed or refractory B-cell NHL.